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At least 685 records · Page 38Linked to original sources
PubMed2000

Willingness to pay for arthritis symptom alleviation. Comparison of closed-ended questions with and without follow-up.

OBJECTIVE: To compare two methods of measuring willingness to pay (WTP): closed-ended questions with and without follow-up. METHODS: A measurement experiment based on dichotomous choice contingent valuation survey data is reported. Marginal WTP estimates for alleviation of rheumatoid arthritis symptoms resulting from treatment with a novel anti-rheumatic agent, cA2 (TNF-alpha blockade), were calculated. Monte Carlo simulations were undertaken to evaluate the methods with respect to their statistical power. RESULTS: The estimated marginal WTP values using closed-ended questions with and without follow-up were DKK 637 (US $91) and DKK 1,268 (US $181), respectively. A Wilcoxon's signed-rank test showed that the difference of DKK 631 was significant. Moreover, including a follow-up question increases the precision of the result. Monte Carlo simulations showed that trade-offs between power (i.e., the probability of a correct rejection of a false null hypothesis), efficiency, and size may exist in the two models. CONCLUSIONS: There was a significant difference between the WTP estimates when using closed-ended questions with and without follow-up. When choosing between the models, however, power, efficiency, and size could be used as selection criteria.

Adult↗
PubMed2000

Willingness to pay in treatment of bleeding disorders.

This paper presents the results of a contingent valuation study measuring willingness to pay (WTP) for treatment of patients with von Willebrand's disease. Median WTP for treatment of this disorder was $1,500 or $3,500, depending on how the initial bid was structured. Regression analysis shows that income, education, and a category rating scale for health status were significant in predicting WTP. The adjusted annual WTP was $2,178. WTP surveys may increasingly be useful for health technology assessment. Starting point bias in how the bids are structured must be recognized.

Attitude to Health↗
PubMed2000

The use of conjoint analysis to elicit willingness-to-pay values. Proceed with caution?

There is a growing interest in the potential use of conjoint analysis (CA) as a tool for estimating patient preferences within the economic evaluation of healthcare technologies. It has been suggested that where cost is included as one of the attributes within the exercise, CA can be used to estimate willingness to pay (WTP) for healthcare interventions indirectly within the framework of cost-benefit analysis. While recognizing the potential advantages of CA as a technique for the assessment of benefits in health care, this paper recommends several avenues of investigation that need to be carefully explored before an informed judgment can be made as to the validity of eliciting WTP values using the CA methodology. It is argued that much can be learned from the use of qualitative research techniques in examining individuals' understanding and interpretation of CA questions where cost is included as an attribute in the exercise. Additionally, further research is required in defining techniques for establishing the most appropriate levels for the cost attribute in a CA exercise and in determining the sensitivity of WTP estimates to the levels that are chosen for the cost attribute.

Costs and Cost Analysis↗
PubMed2003

Health financing policies: patient care-seeking behavior in rural China.

OBJECTIVES: To study the effects of health financing systems on patient care-seeking behavior in rural China. METHODS: A multistage sampling method was used to select county, township, and village health facilities. A total of 1,232 outpatients was interviewed during two weeks. RESULTS: Health-financing systems appeared to influence patient behavior. In the insured group, the proportion of patients being hospitalized was higher than that in the uninsured group. Among the different insurance schemes, the private insurance group had the highest proportion of self-medication, but the cooperative insurance group had the lowest; the government insurance group had the most delay days, but the cooperative insurance group had the fewest. A logistic regression analysis suggested that only "out-of-pocket" payment might decrease the access to hospitalization. CONCLUSIONS: The empirical data suggest that health-financing systems appear to influence patient behavior for prescription and access to health care, especially some costly health care, that is, hospitalization. The data also suggest that China needs to increase the coverage of health insurance, especially in rural areas to improve the access to health care.

Adult↗
PubMed1995

Economic analysis of Alzheimer's disease in outpatients: impact of symptom severity.

To assess the economic burden of Alzheimer's disease (AD), we carried out a cross-sectional prevalence cost-of-illness study in France. Fifty-one probable AD patients (NINCDS-ADRDA) actually treated in ambulatory care were recruited in two university outpatient centers. Demographic, clinical (including actual Mini-Mental State Examination scores), and economic data were collected by clinical investigators and trained interviewers. Total costs included actual expenditures such as direct medical costs and direct nonmedical costs, as well as indirect costs (loss of earnings due to loss of productivity). Cost valuation was based on the societal perspective using an opportunity costing approach. We found that indirect costs represented a significant portion of total costs (36%-40%). In terms of expenditures, patients and caregivers were found to bear the major part of AD total costs. We found a positive and significant correlation between disease severity and costs. Our findings support the hypothesis of a relationship between disease evolution and healthcare costs.

Aged↗
PubMedDate not supplied

Worker decisions to purchase health insurance.

Studying worker health insurance choices is usually limited by the absence of price data for workers who decline their employer's offer. This paper uses a new Medical Expenditure Panel Survey file which links household and employer survey respondents, supplying data for both employer insurance takers and declines. We test for whether out-of-pocket or total premium better explains worker behavior, estimate price elasticities with observed prices and with imputed prices, and test for worker sorting among jobs with and without health insurance. We find that out-of-pocket price dominates, that there is some upward bias from estimating elasticities with imputed premiums rather than observed premiums, and that workers do sort among jobs but this does not affect elasticity estimates appreciably. Like earlier studies with less representative worker samples, we find worker price elasticity of demand to be quite low. This suggests that any premium subsidies must be large to elicit much change in worker take-up behavior.

Adult↗
PubMed2002

The citizen's preferences for financing public health care: a Danish survey.

The Danish public's willingness to forego private consumption in order to obtain improved health care services was investigated using conjoint analysis. The survey was undertaken in the year 1999. 1865 respondents participated in face-to-face interviews and were presented with pair wise choices of different future health care systems. Openness towards the introduction of user charges to a smaller degree demonstrated willingness to compromise relative equity in access to health care in order to avoid a tax increase. Willingness-to-pay for quality attributes lie in the range 780-2350 DKK ($89-$267) if paid by increasing maximum user charges, and in the 0-1220 DKK ($0-$139) bracket, when financed by increased income taxes.

Adult↗
PubMed2002

The contingency of contingent valuation. How much are people willing to pay against Alzheimer's disease?

The present work focuses on the choice of the elicitation technique within a contingent valuation (CV) framework. We simultaneously apply three different elicitation techniques to elicit willingness-to-pay (WTP) values for three programs against Alzheimer's disease. First, the dichotomous choice approach is used, which is the standard procedure. However, giving respondents only a yes/no response alternative seems to result in overestimated WTP values. Therefore, we secondly apply the dissonance-minimizing format which screens respondents for their preferences and thus avoids possible yea-saying and protest answers against the payment vehicle. The third format, a modified version of the payment card, allows respondents to express a level of voting certainty and to make less of a commitment. With our findings we show that a well-designed CV method is a suitable instrument for helping decision makers in the health care sector and that the Swiss population favors highly a program which improves the situation of informal caregivers.

Adolescent↗
PubMed2003

Representative payeeship and mental illness: a review.

Representative Payeeship (RP) is intended to help individuals who are unable to manage disability payments appropriately to meet their basic living needs. This paper reviews the literature on whether RP is effective among individuals with mental disorders. We also review RP's mental health effects and its use as leverage in achieving behavioral goals. RP appears to be effective in helping clients meet their basic living needs; it also may decrease hospitalization and improve treatment compliance. Finally, we propose a research design to disentangle the role of clinical leverage from the more basic money-management function of RP.

Consumer Behavior↗
PubMed2003

Measuring the parental, service and cost impacts of children with autistic spectrum disorder: a pilot study.

The aim of this study was to carry out a preliminary examination of a research instrument developed specifically to collect cost information for individuals with autistic spectrum disorder. There is very little cost information on children or adults with autism or autism-related disorder, and no study appears to have carried out a specific cost collection in this area. Although some global cost estimates can be made, little is known about the cost implications of parental burden. By using different techniques to collect indirect costs, the study outlines a functional methodology. Results from this small pilot study point to considerable economic burden for parents and give some indication of the associated costs of autistic spectrum disorder.

Adult↗
PubMed2003

Unexpected yes- and no-answering behaviour in the discrete choice approach to elicit willingness to pay: a methodological comparison with payment cards.

When measuring willingness to pay (WTP) by contingent valuation surveys, several elicitation methods can be applied. The most common methods are the discrete choice (DC) approach and payment cards. The purpose of this study was to analyse the convergent validity of both approaches in order to investigate different kinds of answering behaviour in these approaches. Unexpected deviations of the answers in the DC approach from the answers provided on the payment cards were analysed, i.e. unexpected yes- (no-)answering was given when respondents stated to the DC question that they are (not) willing to pay a monetary amount while they stated the opposite on the payment cards. Furthermore, we analysed the feasibility of these two elicitation methods. Each of a group of 92 diabetic patients was asked to state their WTP for reductions of the risk of several diabetic complications by both elicitation methods in two surveys. Both elicitation methods were feasible. Compared with the WTP stated on the payment cards, we found unexpected yes- as well as no-answering behaviour in the DC approach which partly balanced each other. At low bids, there was a tendency that unexpected no-outweighed unexpected yes-answering behaviour. At high bids, unexpected yes- outweighed unexpected no-answering behaviour. Overall, unexpected yes-answering behaviour was predominating. Several explanations for these phenomena remain to be investigated.

Aged↗
PubMed2003

Do patients who mismanage their funds use more health services?

One rationale for establishing programs that help patients manage their funds is that such patients make extensive use of expensive inpatient services. We surveyed the money management habits of 406 inpatients and determined their use of Veterans Administration (VA) services and related costs over the subsequent year. In multivariate analyses, there was no statistically significant relationship between need for money management and service use or cost. The misspending of funds for drugs may precipitate hospitalization for some outpatients. However, in a sample of hospitalized patients, mismanagement of funds was not associated with longer length of stay or increased service use following discharge.

Case Management↗